Lecture 4- Mood Disorders

Question 1

Syndrome

Answer 1

Regular coexistence of symptoms

Question 2

DSM Disorder Criteria

Answer 2

Syndrome, loss of function, time course, no better explination

Question 3

Major Depressive Disorder Symptoms

Answer 3

Need 5+ and 1 *
Depressed mood*
Loss of interest or pleasure*
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive guilt
Poor concentration or indecisiveness
Suicidal ideation

Question 4

Major Depressive Disorder Diagnostic Criteria

Answer 4

Distress or impairment in social, occupational, or other functions
5+ symptoms
Symptoms last for at least 2 weeks

Question 5

Depression Throughout Development

Answer 5

Infancy- Anaclitic Depression- Apathetic and lack of expression
Toddler (1-2)- Aggression, hyperactive
Preschoolers- Irritable, social withdrawal
School age- Withdrawal, avoid play, not talking with family, negative beliefs about the world
Adolescents-
12- Pessimistic, sleep problems, decreased appetitie
17- Nightmares, suicidal ideation

Question 6

Abraham-Freud Model of Depression

Answer 6

Aggression turned inward becomes depression; Loss of self esteem

Question 7

Object-Loss Model

Answer 7

Spitz and Bowlby
Separation and disruption of attachment bonds
Insecure caretaker relationship or atmosphere without love

Question 8

Negative Cognitive Triad

Answer 8

Beck
Negative views of self, past, and future
Worthlessness, helplessness, and hoplessness

Question 9

Learned Helplessness

Answer 9

Seligman
False belief that actions have no impact on life events

Question 10

Loss of Reinforcement

Answer 10

Lazarus and Lewinsohn
Lack of positive reinforcements will cause depression

Question 11

Biological Model of Depression

Answer 11

Genetic factors and neurophysical theories
Intrinsic factors

Question 12

Electroconvulsive Therapy (ECT)

Answer 12

Passage of electrical current through brain to create artificial Grand-Mal seizure for treatment-resistant depression

Question 13

ECT Procedure

Answer 13

2 electrodes placed on scalp (both RH) and current passed between them in 1 second intervals until seizure is confirmed and lasts for 30s-1min
Patient is unconscious, paralyzed, and closely monitored
2-3 sessions per week for 6-12 sessions

Question 14

ECT Indications

Answer 14

Treatment resistance severe depression
Delusions, insomnia, loss of appetite, total loss of pleasure

Question 15

ECT Risks

Answer 15

Reaction to anesthesia, cardiac arrest, further seizures or brain damage
Risk worsening depression or suicide without treatment

Question 16

Post Partum Depression

Answer 16

Non-psychotic depressive episode that begins prior to or after delivery and continues into post-partum period
Based on MDD criteria, only needs to last 1 week

Question 17

Postpartum risk factors

Answer 17

Hormonal changes after birth
Low income and social supports
Poor caretaker relationships
History of mood disorders

Question 18

Postpartum treatments

Answer 18

Interpersonal Psychotherapy
Cognitive Behavioral Therapy
Antidepressants (Tricyclic and SSRI)

Question 19

Postpartum Blues

Answer 19

Less severe and more common postpartum depression that is benign and short-lived

Question 20

Post partum psychosis

Answer 20

Severe and rare disorder with sudden onset and rapid depressive and psychotic symptoms

Question 21

Postpartum Disorders Prevalence Rates

Answer 21

Postpartum blues- 30-75%
Postpartum depression- 13%
Postpartum Psychosis- <1%

Question 22

Manic Episode Symptoms

Answer 22

Inflated self-esteem or grandiosity
Decreased sleep
Pressure speech or more talkative
Racing thoughts
Distractibility
Goal-directed activity
Pleasurable activities with consequences

Question 23

Manic Episode Criteria

Answer 23

3+ symptoms
Distress or impairment
Time course (Mania- 1+ week; Hypomania- 4+ days)

Question 24

Bipolar I

Answer 24

1+ manic episodes present

Question 25

Bipolar II

Answer 25

1+ depressive episode and 1+ hypomanic episode
No full mania

Question 26

Dysthymia “Persistent Depressive Disorder”

Answer 26

Depressive symptoms not severe enough to meet MDD criteria
Last for 2+ years a majority of time

Question 27

Cyclothymia

Answer 27

Numerous periods of hypomania and depression for 2+ years but not meeting criteria for full bipolar diagnosis
Often begins in adolescence and 15-50% develop into bipolar

Question 28

Relationship between mood disorders

Answer 28

Unipolar
MDD > Dysthymia
Bipolar
BPD > Cyclothymia

Question 29

Lifetime prevalence rates

Answer 29

MDD- 10-25% women; 5-12% men
Dysthymia- 6%
BPD- 1%
Cyclothymia- 1%

Question 30

Ketamine Treatments

Answer 30

(es)Ketamine nasal spray in low doses has antidepressant and anti-suicide effects with functional reorganization in the brain
Fast acting (within 2 hours) and long lasting (up to 7 days)
Uses as adjunctive therapy
Well tolerated short-term but may have severe side-effects long term

Question 31

Associations with Death

Answer 31

Sleep
Reunion
Happiness and Heaven
Lifelessness
No pain or trouble

Question 32

Suicide Risk Factors

Answer 32

Age (Adolescent and elderly)
Sex (male)
Race (white and native american)

Question 33

Common Suicide Trigger events

Answer 33

Family problems
Loss
Health change
Pressure to succeed

Question 34

Recipe for suicide risk

Answer 34

Negative affect
Method
Alcohol and drug use
Trigger event
Practice

Question 35

Interventions

Answer 35

Create opportunities for honesty and change to determine and remove method

Question 36

Suicide Treatment

Answer 36

Start with antidepressants and follow up with psychotherapy